"The triage area in the hospital is still extremely busy, and people are being treated in the corridor because the ceiling of the emergency room has collapsed," said Japanese Red Cross Deputy Director Rena Igarashi. Ms Igarashi is one of many Red Cross staff members and volunteers who are working around the clock to provide emergency relief.

Landslides and damaged roads have caused serious difficulties in establishing a large field hospital in Minami Aso, a town which has been largely isolated since the earthquake.

"Our first priority is to treat physical injuries. There is still an enormous need for medical aid, but as required Red Cross will also deploy specially trained teams to provide psychosocial support to people who are traumatised after losing relatives or property," said Ms. Igarashi.

Continuous aftershocks have made the population in Kumamoto very worried that another earthquake might strike.

"After the first earthquake I was very scared," said Kazue Kojima, a 38-year-old woman who was forced to evacuate her apartment on the 10th floor of a tall building. "Everything in the rooms was thrown out of its place, so the floor was completely covered. A heavy bookshelf fell on top of my mother while she was sleeping in her bed. By sheer luck she was not injured

"We were better prepared when the second earthquake struck. I had an emergency bag with everything that we would need, and all of us ran out of the house immediately.

Kazue's family is among 385,000 households in Kumamoto who have had no water since the earthquake struck the area.

"I know that many people are in much bigger trouble, but the situation is really difficult. At the moment there is no electricity, no gas, no water and no functioning toilets or showers. We don't even have enough to eat."

Rather than sleeping at home, thousands of people in Kumamoto have chosen to sleep outdoors in open spaces during the night for fear of another strong earthquake. Some are seeking shelter in evacuation centres, with heavy rain forecast in the coming days.

Takeo, a 77-year-old woman visiting the Kumamoto Red Cross hospital, said that despite the difficulties she is much better off than many other people in Kumamoto.

"We came here not because we are injured but because there is water and electricity," Takeo explained, while resting with her 810year-old husband near the hospital's triage area. "I feel much safer when I am here where I can see the Red Cross everywhere."

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